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MS 2 Exam 1 > Lecture 8: Upper Cervical Spine and Headaches > Flashcards

Lecture 8: Upper Cervical Spine and Headaches Flashcards

1
Q

What are some important subjective questions to ask someone about HA during an eval?

A

onset, duration, area of pain, frequency, quality of pain, aggravating factors, relieving factors, meds, PMH, family history

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2
Q

What is prominent motion at AO joint?

A

the nod, flexion and extension

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3
Q

What is prominent motion at AA joint?

A

rotation

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4
Q

What is important to remember about nerves c1-c3?

A

joint dysfunction at upper cervical spine can cause nerve root irritation and referred pain to head and neck

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5
Q

Where does nerve root c1 exit?

A

posterior arch broad groove for the VA artery and sub occipital nerve

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6
Q

Where does nerve root c2 exit?

A

behind superior articular process

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7
Q

Where does nerve root c3 exit?

A

anterior to inferior articular process

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8
Q

What will pain feel like to patient if it is coming from the joint receptors?

A

dull and achy

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9
Q

What will pain feel like to patient if it is coming from the nerve itself?

A

sharp, superficial

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10
Q

What grey matter nucleus is primarily responsible for HA?

A

Trigeminocervical nucleus- nociceptive of the head, throat and upper neck

all afferents from CN 5,7,9,10 and c1-3 nerves converge to this nucleus

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11
Q

Why does referred pain occur with a HA?

A

if neuron receives afferent input from 2 different cervical receptive fields stimulation of one the receptive fields may produce pain in the other

EX: c1 or c2 can be so irritated it cause nausea

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12
Q

What are the three major categories of HA and which can PT treat?

A
  1. migraine
  2. tension
  3. cervicogenic
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13
Q

What are red flags associated with HA?

A

persistent unrelenting HA, associated trauma, supine position increases HA (ICP), visual changes, CNS sx, fever, weight loss, onset with exertion (ICP), temporal arteritis

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14
Q

What must be tested with every pt who presents with HA?

A

CN testing

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15
Q

What is the major cause of onset for migraines?

A

hormonal changes/stimulation (puberty, pregnancy)

lasting 4-72 hours

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16
Q

What is the frequency pattern of migraines?

A

cyclical

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17
Q

What are of the head is usually associated with migraines?

A

unilateral frontal lobe above eyes

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18
Q

What is the quality of pain associated with migraines?

A

mod-severe and pulsating which is different than most types of HA

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19
Q

What type of aggravating factors are associated with migraines?

A

movement- stress, strong sense like smell or loud music

20
Q

What can usually help to relieve migraines?

A

neurotryptan with ibuprofen or indomethacin

21
Q

How is family history and migraines related?

A

runs in families especially in females

22
Q

What are common characteristics of tension HA?

A

insidious onset lasting 30 min to 7 days in a band like pattern around the head

usually mild to mod pain no debilitating caused by stress or tension

23
Q

What can help with tension HA?

A

stress reduction, exercise, NSAIDS

24
Q

What are characteristics of cervicogenic HA?

A

likely caused by micro or macro trauma to neck such as poor prolonged posture or WAD/concussions

can last a few hours or several days which starts as dull ache but then becomes throbbing

25
Q

What area of pain is common associated with CG HA?

A

unilateral- suboccipital or neck

26
Q

What is common cause of CG HA?

A

movement postures or the position of the head on the neck

usually female dominant

27
Q

What other sx can CG HA present with?

A

Nausea, blurred vision, sharp dermatomal pain

28
Q

What are three diagnostic areas to consider with potential CG HA?

A
  1. cervical spine involvement
  2. head pain characteristics
  3. various attack related phenomena
29
Q

What are cervical spine involvement diagnostic criteria for CG HA?

A

reproduced by C- ROM., restrictions in ROM, ipsilateral neck and shoulder pain

30
Q

What are three medical screening tests that need to be done for an Upper c spine eval?

A
  1. VA
  2. ligament stability
  3. CN assessment
31
Q

How can you bias the lower cervical spine for ROM assessment?

A

pre flex upper with a chin tuck

32
Q

How can you bias the upper cervical spine for ROM assessment?

A

flex lower cervical with flexion rotation test

33
Q

What is the flexion rotation test?

A

pt in supine and PT performs passive full cervical flexion and then rotates pt head

positive if ROM is decreased by 10 degrees (norm is 44)

34
Q

What should PT look for on palpation during UCS eval?

A

tension or guarding of superficial muscles, first rib elevation (overactive scalenes)

35
Q

What is purpose of Neural Tension Provocation Test for UCS?

A

tests for reason of restriction in suboccipital muscles, is muscle tight or is tightness due to sensitive nerve which leads to ms guarding

most pts with HA will have muscle guarding

36
Q

What are additional components of an UCS eval?

A

muscle length and muscle control exam (CCFT)

37
Q

Why are the DNF so important?

A

these are postural stabilizers and must stiffen before movement to keep spine as one

38
Q

What is wry neck deformity?

A

common term given to most UCS dysfunction, joint is blocked

39
Q

What are 4 types of wry neck deformities that PT can treat?

A
  1. traumatic
  2. sudden onset
  3. muscular
  4. Post Viral
40
Q

What are 3 types of wry neck deformities we don’t treat?

A
  1. Acquired
  2. spasmodic torticollis- neurological condition
  3. hysterical- psychological
41
Q

What is the most common type of wry neck deformity?

A

traumatic- common in young hypermobile females associated with microtraumas and motor control deficits

42
Q

What is sudden onset wry neck deformity?

A

facet or jt dysfunction , self resolves 1-2 weeks

43
Q

What is you suspect a disc injury with sudden onset wry neck deformity?

A

no manipulation and soft collar for 2-3 days

44
Q

What is muscular wry neck deformity?

A

likely in infants, spasm in SCM causes lateral flexion and CL rotation

usually treated with STM resolves 1-2 weeks

45
Q

What is post viral wry neck deformity?

A

spontaneous onset in child or adolescent after a URI causing temporary insufficiency of UCS ligaments

46
Q

What is important to ask if you suspect post viral wry neck deformity?

A

ask if they’ve been sick lately, was it a URI?

47
Q

What is tx post viral wry neck deformity?

A

NO manual therapy, light ROM, stretching of non neck muscles, exercise, STM

MS 2 Exam 1 (9 decks)

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